The hidden burden

"The hidden burden" The struggle for recognition for those with mental health problems
Every year since 1992, the World Mental Health Day was been held on October 10th. This day is celebrated in 150 countries to promote greater awareness of mental health. Young people is the main focus of this year. World Health Organization (WHO) has defined a hidden burden as a stigma and is characterized by shame, dishonor and criticism resulting in that the individual is avoided or rejected by others. The struggle against such hidden burdens are an important part of public health efforts both nationally and locally.

Many people with mental health problems carry a hidden burden and are fighting a battle to be included and recognized in society. Many people with mental health problems know what this hidden burden is all about, such as when applying for a job. Should one talk about ones mental health problems in a job interview or hide them? How will the others react when they learn that one has been admitted to an institution for people with mental health problems? How does one to speak to those who have been hospitalized in psychiatric institutions? Will any of them find work again after admission to a psychiatric hospital? Why do we unfairly stigmatized those with mental health problems as crazy, insane, insane, idiot, confused, obsessed, dangerous, infirm, and useless?

How large is this public health problem in society today?
 We know today that every fourth approved application for disability benefits, every third person that receives social assistance, and every fifth person who is sick with mental health problems. Today, approximately 12,000 people receive work familiarization money (AAP) from NAV (The Norwegian Labor and Welfare Adminisration).National Strategic Plan for Work and Mental Health (2007-2012), estimates that about 20 percent of those who receive rehabilitation funds (AAP) from Nav has mental health problems. This means that at least 2400 people who receive this support from the Nav in Østfold County in Norway need help to get into employment. These are people with everything from mild to serious mental health problems, some in combination with drug problems. On a national basis, one can assume that there are approximately 35,000 people who receive AAP within the NAV system with mental health problems. These are conservative estimates. In addition, anyone receiving social assistance, sickness benefits and disability benefits.

What can be done?
 Within the NAV system, we find an arrangement that called for Pilots (LOS). This is a scheme, established by the "National Strategic Plan for Work and mental health" to "solve" problems people with minor mental health problems have getting work. There are 54 Pilot consultants in Norway's 457 NAV offices. In Østfold County there is only one Pilot consultant in Sarpsborg and Fredrikstad. Should the country's 54 Pilot consultants take care of all the 35,000 users that we can assume have mental health problems within the AAP, it is closer to 650 users per Pilot. In reality, a Pilot consultant has responsibility to help about 20 users at a time, ie they cover about three percent of the actual need. The experiences we have today with Pilot employees would indicate that the NAV system should focus much stronger on developing this scheme.

Work participation is important for the individual's self-image because it gives recognition and respect. Mastery of life is in our culture to a large extent related to the workplace. Many of those who currently do not have jobs want to be at work. People with mental health problems constitute a significant resource in the community that are not used fully. To use this resource better is not only good economics, it is also good public health.